| NPI | 1205890480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-51903) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0036109) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2026-03-27 |